Woodridge Seeing Great Glycemic Results from Using Glucommander

Woodridge Seeing Great Glycemic Results from Using Glucommander

News Site: The Physician StarDate: October 9, 2015

Johnson City, TN — Controlling blood sugar levels for patients in our hospitals is a constant challenge, and especially so at Woodridge Hospital.

The Mountain States psychiatric facility invariably has patients who need their blood sugar monitored, but people at Woodridge aren't in the same clinically controlled environment as patients in most hospitals. They aren't bed-bound with an IV in their arm, and nobody monitors exactly what, when and how much they eat. Thus, it's harder to control their blood sugar levels.

Particularly troubling at Woodridge are the episodes of very low blood sugar. Patients must be rushed to the Johnson City Medical Center ER to get stabilized before they can return to Woodridge and resume their regular treatment. It makes a difficult time even more difficult for patients.

How did the Woodridge staff conquer this challenge? As part of Mountain States’ Corporate Glycemic Initiative, they implemented Glucommander, a computerized insulin dosing software, to get a better handle on patient glucose levels.

Mountain States was recognized last year by Glytec, which produces Glucommander, for its dramatic early clinical improvements in units that used this tool. Click here to read more about that. One of the questions was how Glucommander would work in a setting like Woodridge.

It’s been a resounding success. Woodridge leaders are proud of what’s been accomplished since the tool was implemented in April.

Patients hospitalized at Woodridge and treated with Glucommander have shown a 26-percent improvement in glycemic control from a starting glucose of 222 mg/dl to a fasting glucose of 164 mg/dl. Hypoglycemia events are very low at 0.40 percent <70 mg/dl versus the baseline of 2.3 percent before Glucommander implementation.

“The results from using Glucommander are excellent,” said Woodridge’s Dr. Rajesh Kadam. “It is much, much better with this tool.”

The Glucommander is a computer software program that uses a mathematical algorithm to adjust how much insulin a patient needs. When Glucommander was initially released more than a decade ago, the software was only used for continuous intravenous insulin drips, with the nurse taking a glucose reading every hour and inputting the results into Glucommander. The software then used that data to control the insulin drip and thus the patient’s glucoses.

At present, most of the time Glucommander is used for patients on IV insulin drips, but two years ago Glucommander’s software and FDA indications expanded to include use for patients receiving subcutaneous basal bolus insulin therapy, an insulin regimen using both long-acting insulin given once or twice daily along with rapid-acting mealtime insulin given before meals

“This truly has the most potential for our patients and presently is very much underutilized, except at Woodridge,” said Dr. Andrew S. Rhinehart, Program Director and Diabetologist at the Johnston Memorial Diabetes Care Center.

At Woodridge, patients are put on a sliding-scale insulin dosage for the first 24 hours in order to measure how much their body is using, and results from that are input into Glucommander, which does its calculations and takes over from there. The program still must be monitored daily for each patient, but it has worked extremely well.

“What we’ve demonstrated with Glucommander is that we have fewer episodes of hypoglycemia,” said Steve Ingram, pharmacist and clinical specialist at Woodridge. “That’s a big thing for our patients.”

Why was this Glycemic Initiative so successful? Teamwork, education to staff, and leadership are big keys.

Another crucial part? “Physician buy-in,” Rhinehart said. “Just getting people to prescribe and use the tool. It’s so beneficial and safe that we need to get everyone to use it. Woodridge’s experience and outcomes certainly prove that it’s safe and effective.”

Dr. Kadam uses the tool regularly and has been a champion of it at Woodridge.

“The staff have been well-trained and understand all the issues,” he said. “We also have to educate the patients but it can be difficult here to impress upon our patients the importance of diet. They are ambulatory so it is very difficult to get them to specifically adhere to the diet they are prescribed. They have access to drinks and snacks that are stocked in the refrigerator. It is a challenge.

“But using Glucommander has made a big difference for us at Woodridge.”

Nurses, dieticians and other staff members have been dedicated to making Glucommander a success; teamwork has been crucial. It also helped that there was strong direction from leadership, including Rhinehart; Dru Malcolm, Chief Nursing Officer for Woodridge; and the Mountain States Corporate Glycemic Initiative’s sponsors, VP for Quality Tamera Parsons and Executive VP and Chief Medical Officer Dr. Morris Seligman.

“I know the dynamics are different for us at Woodridge compared to other hospitals,” Ingram said. “The challenges are different. But it’s really been a success here.”